Healthcare Provider Details

I. General information

NPI: 1548236193
Provider Name (Legal Business Name): DUBLIN OPEN MRI & IMAGING CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CORPORATE SQ
DUBLIN GA
31021-4225
US

IV. Provider business mailing address

102 CORPORATE SQ
DUBLIN GA
31021-4225
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-5177
  • Fax: 478-272-9121
Mailing address:
  • Phone: 478-272-5177
  • Fax: 478-272-9121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number06 02831
License Number StateGA

VIII. Authorized Official

Name: LLOYD WAXMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 631-694-2816